PTC299 in Treating Patients With HIV-Related Kaposi Sarcoma

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To define the safety and toxicity of anti-VEGF small molecule PTC299 in patients with HIV-related Kaposi sarcoma.

To establish the maximum tolerated dose of this drug in these patients.

To estimate the response rate in patients treated with this drug.

Secondary

To describe the pharmacokinetics of this drug in these patients.

To describe the effects of this drug on serum and plasma VEGF, VEGFR, and cytokine profiles in these patients.

To describe the effects of this drug on HIV and KSHV viral loads in these patients.

To describe the effects of this drug on T-lymphocyte subsets (i.e., CD4 and CD8) in these patients.

To describe the effects of this drug on VEGF, VEGFR-2 and -3, phospho-Akt, p53, and HIF-1α expression and tumor cell proliferation, as measured by Ki-67 staining, in tumor biopsy samples obtained from these patients.

To describe the effects of this drug on viral gene expression and cellular gene transcription, as measured by real-time quantitative PCR-based profiling, in tumor biopsy samples obtained from these patients.

OUTLINE: This is a multicenter, phase I dose-escalation study of anti-VEGF small molecule PTC299 followed by a phase II study.

Patients receive oral anti-VEGF small molecule PTC299 twice daily on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Patients who do not demonstrate an objective response of their Kaposi sarcoma (KS) lesions after 6 courses of treatment are removed from the study.

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Patients with GI and/or pulmonary involvement must be asymptomatic or minimally symptomatic and not require systemic cytotoxic chemotherapy

Has at least five bidimensionally measurable cutaneous lesions that have not been previously irradiated AND can be used as indicator lesions

Must have a sufficient number of non-indicator cutaneous lesions measuring ≥ 4 x 4 mm available to obtain a total of four 3-mm punch biopsies (two at baseline and two during the course of study treatment)

Serologic documentation of HIV infection, as evidenced by positive ELISA, western blot, or other federally approved licensed HIV test OR a detectable blood level of HIV RNA

Patients receiving antiretroviral therapy for HIV infection are eligible provided they have been on a stable regimen for ≥ 12 weeks prior to study entry AND there is no evidence of improvement in KS during those 12 weeks or there is evidence of progression of KS within the immediate 4 weeks prior to study entry

No symptomatic visceral KS requiring cytotoxic therapy

PATIENT CHARACTERISTICS:

Karnofsky performance status 60-100%

Life expectancy ≥ 3 months

Absolute neutrophil count ≥ 1,000/mm³

Platelet count ≥ 75,000/mm³

Hemoglobin ≥ 8 g/dL

Creatinine ≤ 2.0 mg/dL

Total bilirubin normal (grade 0)

No specific limit of total serum bilirubin for patient receiveing indinavir or atazanavir therapy AND direct serum bilirubin ≤ 30% of total bilirubin

AST and ALT ≤ 2.5 times upper limit of normal (grade 1)

INR and aPTT normal

Proteinuria < 2+

Not pregnant or nursing

Negative pregnancy test

Fertile patients must use effective barrier contraception during and for up to 3 months after completion of study treatment

Capable of complying with the study, in the opinion of the investigator

No acute, active opportunistic infection (other than oral thrush or genital herpes) within the past 14 days

No history of or ongoing clinically significant illness, medical condition, surgical history, physical finding, ECG finding, or laboratory abnormality that, in the opinion of the investigator, could affect the safety of the patient, alter the absorption of the study drug, or impair the assessment of study results

PRIOR CONCURRENT THERAPY:

More than 4 weeks since prior and no other concurrent anti-neoplastic therapy for KS, including chemotherapy, radiotherapy, local therapy, or biological therapy

More than 60 days since prior local therapy for any KS-indicator lesion unless the lesion has clearly progressed since treatment

Any prior local therapy for indicator lesions (regardless of the elapsed time) should not be allowed unless there is evidence of clear-cut progression of that lesion

More than 28 days since prior and no other concurrent investigational drugs or therapy (other than antiretroviral therapy or agents available on a treatment IND)

More than 30 days since prior major surgery and recovered

More than 14 days since prior treatment for an acute infection (other than oral thrush or genital herpes) or other serious medical illness

No concurrent surgical procedures

No concurrent systemic corticosteroid therapy, other than replacement doses